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Jan 17 02 05: 38p Hi erin&Christ; (41 't8: -00042 w. 1 <br /> 01%15/2002 14:42 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES RHD�OGNUMBER <br /> ENViRONMENTAL HEALTH DIVISION <br /> / 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468.3420 F,4x (A&,r qCr-7'(3 3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �y0 ''1` So f o I-�, BUSINESS/AGENCY <br /> D <br /> ADDRESS f, 21 k H"5S"C/^ 14,,e Sct� Jra uG I <br /> PHONE �" S rI�Q • 7 7O FACSIMILE t`S q ry - 7 1 <br /> TENTATIVE*APPOINTMENT DATE TIME - <br /> (Please 91VO 7 to 10 b siness days from date of application submittal) <br /> &WIT <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT PATE <br /> FILE ADDRESS THIS SIDE EHD STAFF us i:ONLY <br /> PROGRAM ELEMENTS SI;ARCH <br /> ".'!J� C E'r6�1'd'c La.•r e �o �' S 2 (� , <br /> r-1<tito L, Led,' 02qk- <br /> 41, Ctrlc nu.� Lcti Lod, 35 <br /> �q75 i waLg_dllif or <br /> ENVIRONMENTAL HEALTH DIVISION FiLES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 SOLiD WASTE VEHIC_E <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RARCH ❑ PKG TREATMi_NT PLANT <br /> ❑ TiERED PERMITTED FACILITY ❑ MOTEL/HOTEL O PUMPER TRUCK/YARD/CHEM TOILETS . <br /> 0 TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATON 51 FES <br /> Q MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPE"-IFY ABOVE) <br /> 'i. List up to ten addresses in the space above. Select the type(s)of files from the list ab(:,ve by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to_(209)464-0131; ar mail to the <br /> address indicated above, <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be c:%nfirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum Of five business days for review. Appointments should be e:cheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> appilcation may by submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD Mafl at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposil:prior to review. <br /> 5. *TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFiRMED APPOINTMENT PATE TiME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> n.ni_nnr, - <br />